P101264 Davie Academy Rdi a
- 4N
roti of Bedrooms 3
DAVIE COUI= HEALTH DEPARYMENT
SEPTIC TANK P1,211IT
Date !L oCI -
permit is granted to SDA uCv for the installation
o:o a Mepcic Tank at the residence of /o%, Sra lef Address
3,,. i7_di.ng Contractor Address
See: is Tank Specifications: Length Width Depth Capacity 000_Gal,
iianufacturer' s Name Ay: C SPp ii %iy4e . Address
'ao., of lines 11idth w"O in. Total length _ / �D ft, No. of SgXt.960
type of filter material / Total tons used
L __nirnum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House £300 600
Three -Bedroom House 900 900
iIo one shall install a septic tank in Davie Cot;nty w ithout a permit from the
Health Officer or his agent.
.Date of final approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed r31-=-Tyt,��� __ µ
Septic Tank Contracuor
iJote: Make sketch of disposal system on back of sheet and mail to the Health
Center in Hocksville.
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37
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N. C. Form 118 (Revised 7-1-63)
PROPOSED INSTALLATION OF INDIVIDUAL SEWAGE -DISPOSAL AND/OR WATER SUPPLY SYSTEM
Three copies must be completed and accompany each FHA application. After pro-
cessing, one copy will be returned to the mortgagee and one copy to the local
health department.
CASE NO.
Name of Property Owner: J li h �5 n ��%. �7 A ;'I Gv �, ✓ �'
PropertY Address: r00%(?4)ee- ,Ai
(If this properfy is in a development, give lot number and blocknum er
Number of bedrooms proposed s Approximate Area of Lot:Square Feet.
House is to be set back ,!n feet from front'boundary.
I propose to construct on the above captioned property an individual type
sewage -disposal system ri , well �— . This installation will be constructed
so as to meet all the requirements of the local health department, the Federal
Housing Administration and the State Board of Health.
The principal dimensions of these units are:
SEPTIC TANK:
Working Capacity " Gallons
Manufacturer (if precast
?OTE:.If tank has not been specifically approved by the State Board of Health,
submit --plans and- specifica.tiPns.
NITRIFICATION F = -(Lines to_be- of. equal length)..
Percolation Test -Results (At least one per lot required - others if results
indicate necessity. MPS 1103-10)
Hole -No. 1 ` 2 2' �.� 3 f2 ' .4 =' (Minutes per inch of fall)
Total length Feet -._Number of .lines ; Width 3 Feet
Is system-to.be installed to -accommodate: Garbage Grinder Yes ✓No
Washing Machine /Yes No
WELL: 'j�
Type- I3 0 (� P 0 Size of' -storage tank
Drilled, Driven, Bored, Dug)
Make: Type and Capacity of Pump:-
Date -s ! o %
/ �( Signature of Property Owner
A representative of -the /, Q 6 Health Department has inspected
this. site and fin s it suitable for the pr posed installation.
DATE: /a A ? �� �� ( Signed)
(Title)
I£ there is any pertinent information which the sanitarian desires to convey
to the -reviewing officials, which.is not covered above, use the back of this
application.
'This form -is -to be used only by sanitarians specifically authorized by the
State Board of Health.